The Impact of Coordination and Policy Networks on the NHIS

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The Impact of Coordination and Policy Networks on
the NHIS

• Gina Teddy
• AfHEA CONFERENCE MARCH 10TH-12TH

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Outline

• Aim of the paper
• Policy Background
• Methodology
• NHIP Implementation structure
• Coordination and Policy Network
• Discussion
• Result
• Conclusion

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Aim Of the Study

• Outline the complex implementation structure of
  the National Health Insurance Policy (NHIP)
• To identify actors/stakeholders of the scheme
• To examine coordination processes, participation
  and policy networks among actors
• To evaluate the impact of coordination and policy
  networks in implementing the NHIP at the macro,
  meso and micro levels

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Policy Background

• National Health Insurance Policy (NHIP) initiated
  in 2001, legalized in 2003 and implemented in
  2004.
• Main purpose of policy is to replace OOP/CC
  system and increase access
• NHIP consist of 3 main health systems DMHIS,
  PMHIS and PCHIS
• DMHIS is the SHI aspect of the policy
• Implemented nationwide (136)

DMHIS
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Data

• Interviewees
• Policy makers, implementers, scheme and
  healthcare providers, revenue collectors, donor
  agencies, local authorities and other community
  level stakeholders like traditional councils and
  BOG.
• 75 officers in 27 institutions
• Limitation to the Study

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Coordination and Policy Networks

• Multiple agencies intended or unintended to work
  together
• Network of action from the various actors
• Participation, motivation, problem of cooperation
  and negotiation

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Who are the actors in the scheme

• Macro Level - Actors at the national level
  include
• Regulatory bodies
• Financial institutions
• Ministerial bodies
• Donor Agencies
• Other service providers and regulators
• Pressure groups
• Meso Level - Actors at the regional level
• The NHIS Regional Coordinators for GHS
• Regional offices for NHIS
• The Regional Board Network of Mutual Health
  Organization (RBNMHO)
• Micro Actors at the district level
• Traditional Council, Scheme Providers, Health
  Providers, DA, BOG, GHS District Directorates,
  Fieldworkers, Religious leaders, etc

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Levels of Participation and Motivation

• Levels of Participation by actors
• Active - Passive Consultative Remote
• Source of motivation
• Mutual Interest
• Benefit
• Sense of Duty or Legal Obligation
• Continuum
• Explicit or implicit

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Coordination and Policy Network 1

• The NHIP brought together multiple agencies -
  institutions, actors, implementers, stakeholders,
  intended or unintended to work together to
  achieve the primary aim of the NHIP.
• Actors perform independent functions
• Implementation modeled to follow national
  decentralized structure
• But how does it work?

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Coordination And Policy Networks 2

• Coordination through information sharing
• Meetings, reports, emails, stats and data sharing
• Coordination through resource sharing
• Funds, logistics, contracts, expertise, grants,
  loans, donations,
• Coordination through joint actions
• Collaborative actions in service provision,
  information gathering, training, sensitization,
  technical support, monitoring, supervision, and
  planning.

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NHIP Implementation Structure
Major Policy Decision Making
Major implementation level
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Challenges in coordination and policy Networks

• Coordination is challenged by
• autonomous actors - less comitments
• power relations
• ambiguity in functions,
• problematic task consensus
• inconsistencies in implementation practices
• uncoordinated actions,
• lack of trust and suspicion among actors

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Discussion 1- Vertical Coordination

• Coordination at the national level
• Highly limited, formal and less negotiative
• Very problematic although some degree of
  coordination exist
• Coordination with other actors is much more
  effective than the NHIC meetings and reports
  which can be problematic
• Pivotal organization is reluctant to coordinate
  with other actors
• Coordination with district actors is more easier
  than at national level
• Coordination at the regional level
• Is absent
• Coordination at the district/community level
• Coordination is very active, informal,
  interactive and communal
• Active participation among actors at the district
  levels
• Engage actively in coordination and policy
  networking in all spheres of operational and
  implementation processes.

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• there is no official communication . Basically
  there has been no coordination with the council
  our duty is just collecting money and we dont
  have any business beyond that (Financial Officer)
• interactions, if it comes to the national
  level, for now it is poor between providers and
  the NHIS secretariat NHIC in fact there have
  been the wish that, there will be regular
  interaction, but this has been partly because of
  the way the setting up process was. (GHS
  Coordinator)

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Discussion 2 Horizontal Coordination

• Coordination and policy networks very formal
  and limited in content. E.g to meetings,
  directives,
• Top- down coordination, is established and active
  among selected few actors e.g. NHIC GHS, Danida
  and the DMHIS
• Top-down structure lacks the necessary means for
  the devolution of authority down the system to
  confer mutual responsibility among actors
• organizational relationship is not accommodative
  of deferring interest and lack effective conflict
  management
• Implication of horizontal coordination to the
  scheme Inadequate communication and interaction
  between national and regional actors, and
  structured coordination between national and
  district actors

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Coordination and Network Structure
Gap in communication at the regional level
Gap in policy networks at the macro actors
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Conclusion

• Coordination and policy networks is problematic
  at the national and regional levels because poor
  communications within the implementation process.
• Horizontal coordination is structured to include
  selected macro and meso level actors but does not
  follow the administrative structure of
  implementation. Structure is imbalanced due to
  coordination gap at the regional level
• Participation, coordination and policy networks
  at the micro level is relatively active,
  effective and informally efficient.
• Coordination and policy networks must be
  strengthen to enable achieve maximum
  participation and commitments of actors at all
  levels.
• Recommendation NHIC have to negotiate
  coordination more often with other actors and
  create appropriate channels of constant
  interaction with other actors at all levels of
  implementation and institute transparent means of
  sharing infor

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Thank you